Leslie Southard, PharmD, BCACP, CLC is a community pharmacist turned lactation activist on a mission to “provide up-to-date, evidence-based information regarding medications and lactation so individuals are able to make educated decisions regarding their health while reaching their lactating goals, and so healthcare providers can make the best recommendations for their lactating patients,” as she describes in her The Lactation Pharmacist bio.
In honor of Childhood Cancer Awareness Month, Southard’s work and her family’s journey fighting cancer, we’re republishing that piece here on Our Milky Way.
You can find more at The Lactation Pharmacist blog here.
As a newly inducted member of a group no one wants to be apart of – the Cancer Mom group – I’ve had a lot of emotions. Our world changed with one touch, and then one doctor’s appointment, and then a series of tests that led to the ultimate diagnosis: cancer. I’ve never experienced so many emotions in such a short period of time and forced to keep going with the rest of my life. This has led to a lot of thinking and working through what I’m feeling, because you can’t earn a living to support your family if you’re an emotional blob that breaks down every 5 minutes.
Multiple people recently told me “it’s just/only hair, it’ll grow back” when I told them that my daughter’s hair was falling out. This made my blood boil, and it took me a while to figure out why. Here’s the deal – it’s NOT “just” hair. If it was, we’d all be able to just up and shave our heads without any concern. My daughter’s hair represents so much in this cancer journey. We lost our lives as we knew them as soon as the doctor’s appointments and tests started. My daughter is losing a chunk of her childhood – no, not just the part that involves treatment, but the years after for follow up. My husband and I were robbed of the “easy” parental concerns. Now, we’re on high alert any time she spikes a fever, stumbles, mentions something is cold when it’s not, doesn’t pee or poop as much as normal, complains about her stomach hurting, etc. Any of those issues could mean a call to the doctor, a trip to the emergency room, or a side effect of her chemotherapy. Cancer has given me a whole list of worries I never expected. This person had no way of knowing how I’d feel about such a seemingly harmless statement, but it’s important to know that it isn’t and won’t ever be “just” or “only” hair.
This has made me think of all the other times we use the words “just” or “only”. I “just” had a cesarean birth. I “only” lactated for 2 days. I “only” pumped 2 ounces. I “only” lost 2 pounds. It’s “just” a job.
STOP.
By using the words “just” and “only”, you are dismissing all the emotional turmoil something caused you, dismissing all the hard work you put into something, dismissing what the rest of that statement means to you. DROP the “just” and “only” words from your vocabulary. What you did, what has happened to you, what you’re going through MATTERS, and the words ”just” and “only” rob you of that importance.
For as long as there have been humans, there has been human milk. As it happens, according to Greek mythology our entire galaxy originates from breastmilk.
Although people have been breastfeeding for millennia, breastfeeding doesn’t necessarily come naturally, especially in our modern world where common birth practice, industry influence and cultural phenomena are at play.
“The majority of women are not able to fulfill their [infant feeding] goals, and that’s unbelievably sad,” Rojas Bastidas says.
“That’s where innovation comes in,” she continues.
Rojas Bastidas’s company Orolait, is a breastfeeding apparel company at its core, but this summer she released a one-of-a-kind lactation education tool: the LactoPRO Trainer.
The LactoPRO is an anatomically-correct, tissue-mimicking human breast used for demonstrating hand expression. The device features a realistically-sized areola, nipple, and six lactiferous ducts and effectively ejects a human milk-like or colostrum-like substance. The breast is available in various skin shades too.
In April 2020, Rojas Bastidas shifted Orolait operations to help provide Personal Protective Equipment (PPEs) to a hospital in Haiti alongside a Houston-based company that creates surgical organs. With Rojas Bastidas’s vision and entrepreneurship and the company’s patented technology, the LactoPRO Trainer came to fruition.
Rojas Bastidas and the team are working to create a model with inverted nipples as well as fashioning a breast that can develop clogs and mastitis.
Rojas Bastidas emphasizes that she is always working to make her contributions more affordable and accessible.
“Having great things that are not accessible to the community are not helpful to anyone,” she says.
“As I was going through the course and tried to teach hand expression, I became frustrated by the lack of options to demonstrate it accurately and in a constructive way,” she reports.
Evidence-based lactation care emphasizes a hands-off approach. Couple this with the idea that infant feeding is a learned behavior and in American culture we don’t grow up seeing lactating breasts and breastfeeding, hand expression is a terribly abstract practice to teach.
The LactoPRO helps fill this void.
“Innovation in the lactation space has been slow and overlooked, so this is really exciting for me,” Rojas Bastidas says. “I’ve created something for the private sector that’s going to push public perception.”
She likens her invention to the evolution of professional lactation care services; maternal child health advocates took a stand and refused to let women suffer, she explains. Like lactation care, Rojas Bastidas has created something that validates people’s stories and experiences.
Rojas Bastidas’s influence stems from her experience as a new mom and the way she viewed her evolving body.
“I didn’t realize that the way I viewed my body was impacting so much of my life including my breastfeeding journey,” she says.
So many parents sympathize with the conundrum of breastfeeding in public spaces for instance. To do so discreetly often means lifting your shirt and exposing the midsection.
It seems vain and trivial, Rojas Bastidas acknowledges but when you multiply it by the millions of moms who experience challenges like this, there’s got to be a solution.
“Don’t be afraid to tackle whatever problem you see,” Rojas Bastidas encourages. “Innovation is for anyone.”
Rojas Bastidas’s apparel serves as functional fashion. Simultaneously, her pursuit celebrates the bodies that have been largely misrepresented and often altogether censored.
“The absence of bodies sends a broader message that those bodies don’t exist,” she explains.
“It makes every battle so much harder, but that’s what keeps driving me. I should have just closed up shop because this is so hard, but I’m going to make as many people as uncomfortable as humanly possible,” Rojas Bastidas says of being a female innovator in health and wellness advocacy.
She adds that by showing the public what bodies actually look like, it frees us, elevates us and empowers us.
“Lactating individuals deserve to be seen, heard and helped.”
Rojas Bastidas has a lot to offer on her website including her shop, lactation counseling services, a member forum and blog. Check it out here.
The team at Reaching Our Sisters Everywhere (ROSE) exemplifies resilience through tumultuous times. A bright spot shone through tragic recent events when the Georgia Supreme Court unanimously ruled in May 2020 that ROSE’s constitutional challenge to the state’s 2016 Georgia Lactation Consultant Practice Act will go forward.
Source: United States Breastfeeding Committee.
Our Milky Way spoke with ROSE Chief Empowerment (CEO) and Change Leader Kimarie Bugg, DNP/FNP-BC/MPH/IBCLC/CLC, Vice President Mary Nicholson Jackson, CLC and Program Director Andrea Serano, CLC, IBCLC who provided an update and commentary on the case.
The team says that the recent reversal feels like a victory because it means that the 2016 law is still not enforceable and lactation care providers (LCPs) with any credential can continue their work.
“The problem is that it’s still being misinterpreted in some places,” Jackson explains. “Sometimes trying to figure out what’s going on is the real concern.”
The Georgia Lactation Consultant Practice Act calls to prohibit provision of lactation care and services for compensation without obtaining IBCLC licensure. But in June 2018, the court put a freeze on the implementation of the law after Jackson, in partnership with the Institute for Justice (IJ) and ROSE, filed a lawsuit to preserve the right to earn an honest living.
The recent reversal affects close to 1,000 Certified Lactation Counselors (CLCs) among other breastfeeding helpers practicing in Georgia, all of whom would have not been lawfully permitted to continue their work under the law after July 2018.
The ROSE team explains that while LCPs continue to legally offer services and support, there’s still some confusion within the community. Individuals lobbying for the Lactation Consultant Practice Act have offered up erroneous guidance at places of employment for example.
Especially in the current context of Covid-19, the team expresses relief that they and other lactation supporters are still able to provide support to families. Many long-standing and already-dire situations have been illuminated and compounded during the pandemic, like labor and birth support.
In Georgia, only one support person is allowed to accompany a laboring person in certain maternity care facilities, and that support person is not allowed to leave and return to the hospital. In many cases, this restriction is not sustainable for families who have other children or employment obligations.
“We know that if [the law] would have been in effect, [birthing people] could not fall back on the resources that they know of and are familiar with after already being traumatized after labor and birth,” Bugg explains.
Source: United States Breastfeeding Committee.
Racial inequities and structural racism have been brought to the forefront of our national conversation especially in light of Covid-19, and the issues at hand are no different in the world of lactation.
Not surprisingly, some have suggested that the entire premise of the Lactation Consultant Practice Act is fraught with racism.
The case is not only about economic freedom, but equally important, access to lactation care especially in marginalized communities.
Jackson’s petition points out that “the Act defeats its own purpose of promoting public health because it will, overnight, put hundreds of highly qualified lactation consultants… out of business. This will dramatically reduce breastfeeding support statewide, particularly in the minority and rural communities where CLCs are most active.”
Pages 19 to 25 of the petition detail ways in which the Act causes harm to LCPs including those who work as milk lab technicians, Baby Café support people, military families, and the list goes on.
In Why is That IBCLC Licensure Lawsuit in Georgia Such a Big Deal? author Liz Brooks, JD, IBCLC, FILCA details how lactation professionals of color are disproportionately impacted by the 2016 Act citing one example in particular where an African American RD IBCLC practitioner of many years had her application halted.
Brooks writes, “The systemic racism is made obvious because an IBCLC of color now has to take the time, and money, and lawyer up, and dig through paper work from 29 years ago, and file an appeal, and show people that she is an excellent, honest, forthright person who just wants to **continue** working to help families breastfeed/access human milk, which is what she was showing them when she filed her license application in the first place.”
IJ explains that the “drive toward licensure is not motivated by health or safety concerns, but rather by IBCLCs’ interest in billing health insurance companies for their services.”
“In 2010, the Affordable Care Act mandated that insurance companies provide coverage for lactation services. Since then, insurance companies have used licensure as a means of limiting the expense of that coverage. To ensure they could bill insurance companies, the IBCLCs’ lobbyists have begun pushing state-mandated licenses across the country to artificially differentiate IBCLCs from CLCs,” the IJ statement continues.
Source: United States Breastfeeding Committee.
SELCA released a response in regard to the Georgia Lactation Consultant Practice Act claiming that the law’s passing “has already improved access to clinical lactation care” citing new jobs, a community college program, and the promise of in-network lactation consultants for mothers using Medicaid.
The ROSE team reports that this large scale change has not transpired.
“That panacea that they thought was going to happen has not happened,” Bugg says.
“Who in the heck thinks any license, waived high over their head by an IBCLC, will now instantly generate credibility, job offers, insurance company cooperation, money in the bank? Anything having to do with payment for/coverage of health care services in the USA in 2018 is a humongous pain-in-the-neck. Ask any hospital, doctor, nurse, midwife, speech therapist, dentist, etc etc etc just how easy-peasy it is to see patients, spend quality time with them, have all services fairly and easily covered, and so on. Yeah. Not so much.
I’ve said it countless times: The issue should be about HOW to pay [for lactation care, from counseling on up through skilled clinical care], not WHO to pay [which is what flawed and even better-than-most licensing bills necessarily must focus on].”
While ROSE moves forward, Serano urges maternal child health advocates to keep the issue of licensure on the radar on a state-by-state basis. When legislation is presented, look at it through an equitable lens, she suggests. Educate local and federal legislators.
On this note, starting at the state level is an effective way to vindicate rights for others, as pointed out in IJ’s video Can the Government Throw You Out of Work? (Not in Some States!). An IJ attorney explains that the U.S. has a long history of looking at what state high courts have done, and that it’s a traditional method for achieving constitutional change.
It’s important to make clear that it is not solely the fault of one or a handful of organizations or individuals for carrying out a racist agenda. We are all called to this work, striving for an antiracist society.
You can stay up to date and support this ongoing case here.
“I had a very adventurous time with those guys in the NICU,” Boyd remembers. “It changed the way I thought about breastfeeding.”
As a young Black mother, Boyd says she feels fortunate to have had support from hospital staff to feed her twins (which she went on to do for three years), acknowledging that this is not often the case for BIPOC families.
“That support in turn gave me the desire to help other mommies,” she says.
Boyd’s passion lies in uplifting underserved communities, particularly families living in the rural regions of the Southeast U.S. where she lived for nearly 20 years.
Now located in Florida, Boyd’s newly released podcast,The Early Postpartum Period, offers a way to stay connected and reach underserved mothers with basic, relevant breastfeeding information.
Boyd admits that the technology was something new to her and it required much patience to bring the project to fruition. Still, she says, it’s something that she wants to commit to for a long time to come, connecting with families especially in the time after they’ve left the hospital. Boyd hopes to soon host focus groups to get a better understanding of what kind of information families would like her to cover in the episodes.
In the meantime, she plans to release more episodes over the summer. Her practice emphasizes the importance of organization, so she’s planning a podcast featuring organizational skills and time management tips.
“There is a lot of lactation education out there and I don’t want to be repetitive,” Boyd begins. “I want to hit areas that will really be relevant and give [parents] something they can use, not just something they can listen to.”
Boyd explains that learning organizational skills can bring a sense of calmness which allows parents the energy to move forward with daily tasks, rather than getting engulfed by an often chaotic world. She suggests things like preparation, avoiding procrastination and working up endurance through taking a breath and stepping away when necessary.
Especially as our country examines our foundations and current events have brought race to the forefront, Boyd emphasizes the urgency to address high Black maternal mortality rates.
The pandemic has illuminated ways in which to address these rates, Boyd explains, like out of hospital birth and doula support.
“We have to move forward,” Boyd encourages.
You can connect with Boyd on Twitter here and find her website here.
Recently, Healthy Children Project put out a statement about our stance on the current events. “These are incredibly trying and painful times. As we negotiate the very current multiple impacts of the COVID-19 pandemic, recent events remind us that systemic racism and social injustice are longstanding national plagues…For too long families of Black and Brown babies have lived in fear for their children, themselves and their loved ones. The Healthy Children Project and the Center for Breastfeeding will not tolerate injustice, hate, bigotry and racism in any form.”
We expressed our solidarity with birthing families, our staff, our participants, our families, our communities, and our friends and hold Black, Indigenous , Mothers of Color in our hearts, our mission and our vision and reiterated that we will not tolerate injustice, hate, bigotry and racism in any form. We especially remember the words of Dr. Martin Luther King, Jr. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
Our mission and focus is all about supporting mothers and their breastfeeding journeys. We know that Black women experience maternal mortality and morbidity at three to four times the rates of white women and infant mortality is twice as high for babies born to Black mothers when compared to babies born to white mothers. We also know that breastfeeding can help mitigate both of these unacceptable disparities.
We are taking steps to help Black mothers and Black communities while staying focused on what we do best; train people to assist with breastfeeding.
Healthy Children Project and the Center for Breastfeeding has always been committed to making lactation care community diverse and equitable. We have worked to make the Lactation Counselor Training Course (LCTC) accessible by giving scholarships each year to organizations such as ROSE and HealthConnect One.
But we realized that we could do even more. Towards that end, we announce that we have started an initiative called Accessing the Milky Way. This initiative will send Black, Indigenous , People of Color to the online LCTC by offering scholarships that range from partial to full.
The first phase of this initiative will provide full tuition for the online LCTC on full scholarship for 25 BIPOC. This Accessing the Milky Way scholarship will pay the entire tuition for the course.
In addition, we have started a fund to pay for the required text book and the testing fee for each of the 25 recipients to further eliminate barriers to becoming a Certified Lactation Counselor.
We invite you to nominate a person that you know who wants and deserves the opportunity to take the LCTC in order to better serve and support the mothers in their community. We will be accepting nominations now through July 10, 2020. If you would like to nominate an individual, please send an email to info@centerforbreastfeeding.org and include the nominee’s name, phone number, email address, city and state, and a short description of the work they are doing and the benefit to their community by them becoming a Certified Lactation Counselor. Self-nominations are welcome.
There are two fixed costs that cannot be covered by the scholarship. The cost of the text book is $75.75 and the fee to take the exam after the class (administered by the Academy of Lactation Policy and Practice) is $120. This additional $195.95 is another barrier to BIPOC getting training that will support the families in their communities. Healthy Children Project faculty is working to raise a total of $4900 which would cover these fixed costs for all 25 recipients of the scholarship. Those interested in growing this fund may visit the GoFundMe page here.
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As a newly inducted member of a group no one wants to be apart of – the Cancer Mom group – I’ve had a lot of emotions. Our world changed with one touch, and then one doctor’s appointment, and then a series of tests that led to the ultimate diagnosis: cancer. I’ve never experienced so many emotions in such a short period of time and forced to keep going with the rest of my life. This has led to a lot of thinking and working through what I’m feeling, because you can’t earn a living to support your family if you’re an emotional blob that breaks down every 5 minutes.
